Rare neurological complications associated with critically ill pediatric diabetic ketoacidosis—a report of two cases

This case series highlights rare reversible neurological complications encountered in two children who presented with diabetic ketoacidosis (DKA) and were critically ill. The first child was a 5-month-old baby with transient neonatal diabetes who had prolonged coma, atypical findings of diffusion restriction on neuroimaging and later quadriplegia due to rhabdomyolysis when he presented with DKA. The second child was a 16-year-old boy with classical type 1 diabetes mellitus who developed quadriplegia due to rhabdomyolysis and polyneuromyopathy. Both the children were critically ill with hemodynamic compromise, renal impairment and dyselectrolytemia. Both had full recovery on follow-up at the end of 1 month and 10 months, respectively. The severity of DKA at presentation with altered sensorium and/or hemodynamic compromise with renal involvement and dyselectrolytemia and a coexistent infection may have more propensity for such complications. Strict implementation of DKA management guidelines and a multidisciplinary approach to deal with the critically ill child is needed to optimize the outcome in such situations.